Last-minute lobbying threatens $200B Medicare package

Lawmakers and lobbyists representing children’s insurance advocates, seniors’ healthcare providers and other specialty groups are pressing to amend a $200 billion Medicare package the Senate hopes to send to President Obama’s desk next week.

The underlying bill would permanently change Medicare to prevent cuts in physician payments that Congress has had to repeatedly patch for more than two decades.

{mosads}The 263-page package was approved overwhelmingly by the House but represents a delicately negotiated compromise. Proponents fear the last-minute demands could sink a bill crafted in part by Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.).

“We’re saying, ‘Please, please, please don’t amend it,’” a representative for one doctor’s group said.

Much of the work by Boehner and Pelosi was done behind the scenes, and a number of healthcare groups feel they were left out of the process.

The package would extend the Children’s Health Insurance Program (CHIP) for two years, but some lobbying groups want four years.

“We still think we can get four years. We’re pushing hard to do it,” said Ed Walz, the vice president of communications for First Focus Campaign for Children. “We’ve had interesting — and interested — conversations about a very real possibility of an amendment.”

AARP is concerned with the way lawmakers plan to pay for the $200 billion bill, in part by raising costs on some beneficiaries.

The senior group’s healthcare lobbyist, Ariel A. Gonzalez is proposing changes to the legislation that would offer some assistance to people who could be forced to pay more.

One of the country’s largest doctor groups, the American Academy of Family Physicians, is urging the Senate not to consider changes to the bill to ensure that nothing derails the legislation.

“We really think a clean bill would hasten the process and that amendments would probably just slow the process down,’ Dr. Robert Wergin, president of AAFP, said in an interview Monday.

One lobbyist echoed those comments.

“The negotiations in the House reflect a delicate balance that was achieved to satisfy different constituencies,” a lobbyist familiar with the issue said. “As people advance amendments, one has to gauge to what extent that is going to alter that balance.”

Senate Majority Leader Mitch McConnell (R-Ky.) has declined to say whether the bill will include amendments. Don Stewart, his spokesman, said Monday of the decision on amendments: “We expect it will be done quickly.”

Senate Minority Leader Harry Reid (D-Nev.), before the Senate’s recess, suggested “a very limited number of amendments with time agreements on them.”

Days earlier, White House spokesman Josh Earnest also said the president would support any amendments “that are directed toward improving the legislation.”

The remarks gave hope to healthcare groups who hope to win changes to the bill.

Timing could make it difficult to amend the bill.

When the Senate returns on Monday, it will have just two days to pass a bill, or Medicare doctors will face double-digit cuts in their reimbursement rates. If the bill is amended, the House would either need to vote on that legislation, or there would need to be a lengthy conference involving negotiators from both chambers. 

Wergin said, while every healthcare group could find pieces of the House bill it would like to change, it’s more important to ensure that Congress actually repeals the Sustainable Growth Rate formula in Medicare that threatens to cut physician payments.

“I think each group would say, ‘Gee maybe there’s a certain change I’d like to have,” he said. “But there’s enough in there for everybody that we think we could get it over the finish line.”

A degree of gamesmanship is involved in the wrangling.

Some advocates have been pushing their causes for the last two weeks almost entirely for show, said one lobbyist close to the talks.

“A lot of these are people looking to have one last shot, have the issue raised, and maybe use that for future activity,” the lobbyist said.

In most cases, the lobbyist said the groups will be better off with the compromise than without it — specifically pointing to advocacy groups that have banded with Senate Democrats to push for a four-year extension to CHIP.

“If two [years] is what you have, are you really going to blow up the deal?”